A standardization approach to compare treatment safety and effectiveness outcomes between clinical trials and real‐world populations in psoriasis

Autor: Yiu, ZZN, Mason, KJ, Barker, JNWN, Hampton, PJ, McElhone, K, Smith, CH, Warren, RB, Griffiths, CEM, Lunt, M, Burden, AD, Study Group, BADBIR
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Q1
law.invention
Etanercept
030207 dermatology & venereal diseases
0302 clinical medicine
Randomized controlled trial
law
Registries
Randomized Controlled Trials as Topic
Aged
80 and over
education.field_of_study
Incidence
R735
Middle Aged
Reference Standards
3. Good health
Treatment Outcome
Research Design
Cohort
Female
Ustekinumab
medicine.drug
Adult
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
RL
Population
Dermatology
03 medical and health sciences
Young Adult
Psoriasis Area and Severity Index
Psoriasis
Internal medicine
medicine
Humans
education
Aged
Biological Products
business.industry
Patient Selection
Adalimumab
Original Articles
medicine.disease
R1
Clinical trial
Logistic Models
Propensity score matching
Multivariate Analysis
General Dermatology
business
Zdroj: The British Journal of Dermatology
Yiu, Z Z N, Mason, K J, Barker, J N W N, Hampton, P J, McElhone, K, Smith, C H, Warren, R B, Griffiths, C E M, Lunt, M & Burden, A D 2019, ' A standardization approach to compare treatment safety and effectiveness outcomes between clinical trials and real-world populations in psoriasis ', British Journal of Dermatology . https://doi.org/10.1111/bjd.17849
ISSN: 1365-2133
0007-0963
DOI: 10.1111/bjd.17849
Popis: Summary Background Patients recruited in randomized controlled trials (RCTs) for biologic therapies in psoriasis are not fully representative of the real‐world psoriasis population. Objectives Firstly, to investigate whether patient characteristics are associated with being included in a psoriasis RCT. Secondly, to estimate the differences in the incidence of severe adverse events (SAEs) and the response rate between RCT and real‐world populations of patients on biologic therapies for psoriasis using a standardization method. Methods Data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) were appended to individual participant‐level data from two RCTs assessing ustekinumab in patients with psoriasis. Baseline variables were assessed for association of being in an RCT using a multivariable logistic regression model. Propensity score weights were derived to reweigh the registry population so that variables had the distribution of the trial population. We measured the C‐statistic of the model with trial status as the dependent variable, and the risk differences in the incidence rate of SAEs in the first year and Psoriasis Area and Severity Index (PASI) after 6 months in the BADBIR cohort before and after weighting. Results In total 6790 registry and 2021 RCT participants were included. The multivariable logistic regression model had a C‐statistic of 0.82 [95% confidence interval (CI) 0.81–0.83]. The risk differences for the incidence rate of SAEs and the proportion of patients with PASI < 1.5 were 9.27 (95% CI −3.91–22.5) per 1000 person‐years and 0.95 (95% CI −1.98–4.15), respectively. Conclusions Our results suggest that RCTs of biologic therapies in patients with psoriasis are not fully representative of the real‐world population, but this lack of external validity does not account for the efficacy–effectiveness gap. What's already known about this topic? Patients with psoriasis who would not be eligible for randomized controlled trials (RCTs) investigating biologic therapies have a greater risk of serious adverse events and lower treatment effectiveness than patients who would have been eligible. What does this study add? Baseline patient characteristics were shown to be predictive of whether a patient would have been eligible for enrolment in an RCT for psoriasis biologic therapy.We did not find any efficacy–effectiveness gap between the sample representative of the real‐world population of patients with psoriasis and the sample representative of the RCT population.Factors outside of baseline patient characteristics, such as observer effect and higher adherence in RCTs, may be more influential in any efficacy–effectiveness gap between trial and real‐world populations of patients with psoriasis.
https://www.bjdonline.com/article/a-standardization-approach-to-compare-treatment-safety-and-effectiveness-outcomes-between-clinical-trials-and-real-world-populations-in-psoriasis/
Databáze: OpenAIRE
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